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will catalyze retailization of health care The ACA will catalyze The theACA retail-ization of healthcare. a phenomenon that was already underway Three Redefining Phenomena 2020 Retail Exchange Marketplace
Tomorrows exchange market 40-60 million members from small employers/ defined contribution exchanges Todays individual market 14 million members 2012 40 million individuals 2019
The retail market will include more than 100 million consumers by 2020.
subsidies outlined in the ACA, simplifying payment and administration for payers and employers.
bility checks and ensure that payers leverage the public exchanges for lead generation.
vidualized plans and match the variety of offerings on a private exchange to the individual market or employee target audience. strategies and leverage access to new analytics. New messages, channels and state-of-theart shopping experiences are necessary to reach a new mix of consumers, many of whom will expect personalized communications about plans and offerings tailored to their needs and accessible on devices of their choice. functionality to benefits administrators will be a key differentiator for payers. Some of the salient features include employee management, defining classes, access to reporting, billing and payment tracking, and payroll calculations. fer consumers a well-designed, familiar shopping experience. Millennial generation employees will expect private exchange features and follow-up service to match those they use on other online shopping sites, such as easy comparisons and user reviews. need to manage the integration of member data, enrollment processes, customer service and defined contributions into existing payer and employer systems to provide streamlined administration, such as offering employers a single place to view invoices. Payers must continually evaluate private exchange results, gauging metrics such as consumer acceptance, plan performance, shopping trends, etc. Like other retailers, payers will need to use these results to adjust offerings and exchange features to respond quickly to customer demands.
Offer
additional value-generating products. Payers may add ancillary products that are not subject to medical loss ratio regulations on private exchanges. These can include vision, dental, wellness, pet care, financial products and more, increasing options and serving a full range of individual needs. ers can balance the cost control of defined contributions with meaningful employee choice, making the private exchange model especially attractive in the changing healthcare market. diversify sales channels. A single-carrier private exchange enables payers to respond to market expectations and develop a channel that contributes to the bottom line. Whether or not a payer participates in a public exchange, a private exchange represents a strategic shift and is a response to increasing direct-to-consumer relationships and sales in healthcare. in parallel with public exchanges. On a public exchange, small group employees and individuals can select insurance plans, although not all of them will be eligible for federal health insurance premium subsidies. A private exchange enables payers to give employers, employees and individuals another option, one likely to offer a better user experience, excellent customer service and a wider array of products from which to choose. For individuals who are eligible for subsidies, having a private exchange will integrate eligi-
Strategically
Work
Analytics:
Communication Channels
E-mail Chat Web Paper Phone
Identifying
stakeholders (billing, client relations, IT, marketing, membership, producers/ producer relations, product, sales, training, underwriting) and developing an implementation roadmap. business and systems ecosystems.
Remodeling
back-end support processes for managing defined contribution reporting, payroll deductions, accounting and tax reporting. how billing data and invoices, enrollment and member management systems, products, sales and commissions
will be designed and integrated into the private exchange. Once payers understand the new processes and skills required for successful private exchanges, they can then evaluate their internal abilities to create or enhance these capabilities.
Understanding
Footnote
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About Cognizant
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